美国退伍军人事务部女性退伍军人子宫切除率的趋势。

Trends in hysterectomy rates among women veterans in the US Department of Veterans Affairs.

作者信息

Katon Jodie G, Gray Kristen, Callegari Lisa, Gardella Carolyn, Gibson Carolyn, Ma Erica, Lynch Kristine E, Zephyrin Laurie

机构信息

Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA.

出版信息

Am J Obstet Gynecol. 2017 Oct;217(4):428.e1-428.e11. doi: 10.1016/j.ajog.2017.05.057. Epub 2017 May 31.

DOI:10.1016/j.ajog.2017.05.057

PMID:28578175

Abstract

BACKGROUND

Prior studies demonstrate a higher prevalence of hysterectomy among veterans compared with nonveterans. While studies identify overall decreasing hysterectomy rates in the United States, none report rates of hysterectomy among women veterans. Given the increasing numbers of women veterans using Veterans Affairs health care, there is an ongoing need to ensure high-quality gynecology care. Therefore, it is important to examine current hysterectomy trends, including proportion of minimally invasive surgeries, among veterans using Veterans Affairs health care.

OBJECTIVE

Our objective was to describe hysterectomy trends and utilization of minimally invasive hysterectomy in the Veterans Affairs healthcare system.

STUDY DESIGN

This longitudinal study used Veterans Affairs clinical and administrative data from fiscal year 2008 to 2014 to identify hysterectomies provided or paid for by Veterans Affairs. Crude and age-adjusted hysterectomy rates were calculated by indication (benign or malignant), mode (abdominal, laparoscopic, vaginal, robotic assisted, unspecified), and source of care (provided vs paid for by Veterans Affairs). Mode and indication for hysterectomy were classified using International Classification of Diseases, ninth revision, codes. The distribution of hysterectomy mode in each year was calculated by indication and source of care.

RESULTS

Between fiscal year 2008 and fiscal year 2014, the total hysterectomy rate decreased from 4.0 per 1000 to 2.6 per 1000 unique women veteran Veterans Affairs users. Age-adjusted rates of abdominal hysterectomy for benign indications decreased over the study period from 1.54 per 1000 (95% confidence interval, 1.40-1.69) to 0.77 per 1000 (95% confidence interval, 0.69-0.85) for procedures provided by Veterans Affairs and 0.77 per 1,000 (95% confidence interval, 0.69-0.85) to 0.29 per 1,000 (95% confidence interval, 0.23-0.34) for those paid for by Veterans Affairs. Among hysterectomies for benign indications provided by (n = 5296) or paid for (n = 2610) by Veterans Affairs, the percentage of hysterectomies performed abdominally decreased from 67.2% to 46.8% and from 68.9% to 57.6%, respectively.

CONCLUSION

These findings suggest that gynecology care provided within Veterans Affairs has kept pace with national trends in reducing hysterectomy rates and increasing utilization of minimally invasive surgical techniques.

摘要

背景

先前的研究表明，退伍军人中子宫切除术的患病率高于非退伍军人。虽然研究表明美国子宫切除术的总体发生率在下降，但尚无关于女性退伍军人子宫切除术发生率的报告。鉴于使用退伍军人事务部医疗保健服务的女性退伍军人数量不断增加，持续需要确保高质量的妇科护理。因此，研究使用退伍军人事务部医疗保健服务的退伍军人当前子宫切除术的趋势，包括微创手术的比例，非常重要。

目的

我们的目的是描述退伍军人事务部医疗保健系统中子宫切除术的趋势以及微创子宫切除术的应用情况。

研究设计

这项纵向研究使用了2008财年至2014财年退伍军人事务部的临床和行政数据，以确定由退伍军人事务部提供或支付费用的子宫切除术。按指征（良性或恶性）、手术方式（腹部、腹腔镜、阴道、机器人辅助、未明确）和护理来源（由退伍军人事务部提供与支付费用）计算粗子宫切除率和年龄调整后的子宫切除率。子宫切除术的方式和指征使用国际疾病分类第九版编码进行分类。每年按指征和护理来源计算子宫切除术方式的分布情况。

结果

在2008财年至2014财年期间，每1000名使用退伍军人事务部医疗保健服务的女性退伍军人中，子宫切除术的总发生率从4.0降至2.6。在研究期间，退伍军人事务部提供的良性指征腹部子宫切除术的年龄调整率从每1000人1.54（95%置信区间，1.40 - 1.69）降至每1000人0.77（95%置信区间，0.69 - 0.85），由退伍军人事务部支付费用的此类手术从每1000人0.77（95%置信区间，0.69 - 0.85）降至每1000人0.29（95%置信区间，0.23 - 0.34）。在退伍军人事务部提供（n = 5296）或支付费用（n = 2610）的良性指征子宫切除术中，腹部子宫切除术的比例分别从67.2%降至46.8%和从68.9%降至57.6%。